Ultra hypofractionated breast radiotherapy according to the Fast-Forward scheme: Excellent early tolerance or delayed skin reactions? Real life experience

Abstract

Purpose

Over the past three decades, the fractionation of radiotherapy for breast cancer has evolved, with a trend towards hypofractionated regimens. The Fast-Forward trial evaluated a radiotherapy protocol in five daily fractions, offering a potentially effective and more convenient alternative to conventional regimens. The primary objective of our study was to evaluate acute skin reactions in patients receiving hypofractionated adjuvant radiotherapy for breast cancer according to the Fast-Forward protocol, along with their time to onset.

Materials and methods

This retrospective single-centre study was conducted at the institut Curie, including all patients treated for early breast cancer with radiotherapy according to the Fast-Forward regimen (26 Gy in five daily fractions). Follow-up was performed by clinical examinations and mammography; skin toxicity was assessed according to CTCAE v.5 criteria.

Results

Between December 2014 and December 2022, 255 patients were treated according to the Fast-Forward regimen. The median age of patients was 76 years. Of these, 93.7 % had invasive carcinomas, and 93.3 % had tumours staged T1 or T2. Treatments were performed in supine position for 46.3 % of patients and in isocentric lateral decubitus position for 53.7 %. Acute radiodermatitis was observed in 35 patients (13.7 %) mainly grade 1, and 4 patients (1.6 %) had grade 2 radiodermatitis. Acute radiodermatitis occurred after a mean period of 1.6 months. Delayed toxicity events were noted in 24 patients (9.4 %), including oedema, persistent skin pigmentation, and breast fibrosis, 1.2 % of which were grade 2. No acute or delayed toxicity of grade 3 or higher was reported.

Conclusion

The efficacy and good tolerance of the adjuvant breast irradiation regimen of 26 Gy in five fractions has already been proven. Monitoring of this homogeneous group of patients highlighted the possibility of delayed acute skin reactions. Further consultation during treatment seems necessary to diagnose and treat these reactions.